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NRNP 6675 Midterm Exam Walden University 2023-2024, Exams of Nursing

NRNP 6675 Midterm Exam Walden University 2023-2024

Typology: Exams

2023/2024

Available from 06/13/2024

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Download NRNP 6675 Midterm Exam Walden University 2023-2024 and more Exams Nursing in PDF only on Docsity! NRNP 6675 Midterm Exam Walden University 2023-2024 Discrepancy between anatomical sex and gender is known as? B) Gender Discordance Which of the following are risk factors for neuroleptic malignant syndrome? Select all that apply Rapid dose escalation; parental route of administration; higher potency typical antipsychotic Antipsychotic medication provides D2 blockage in the meso-coritcal pathway causing which of the following effects? B) Increases EPS Incorrect: reduces negative s/s, causes prolactinemia, reduces positive symptoms Phencyclidine (PCP) and ketamine exert their unique behavioral effects by blocking which of the following receptors? D) NMDA type receptors Incorrect: GABA, serotonin, dopamine "receptors" The diagnosis used to describe a syndrome characterized by specific s/s resulting from recent ingestion or exposure to a substance is known as which of the folllowing? C) Substance use disorder Incorrect: substance intox, substance withdrawal, all of the above Abnormal involuntary movements in a rhythmic pattern affecting the face, mouth, tongue jaw is known as which of the following? C) Tardive dyskinesia Incorrect: akathisia, dystonia, EPS A deeply held belief despite evidence to the contrary, lasting at least 1 month, without prominent hallucinations, with functional impairment that relates to the delusional system disorder called? Delusional disorder Which of the following is true about preoccupation with castration? A) This can be serious and life threatening if castration is carried out without medical supervision Incorrect: consistent with transvestiatic disorder, other specified paraphillic disorder, or sexual machochism disorder Which of the following is a system that provides a uniform language for describing medical and surgical procedures and diagnostics services rendered by clinicians? CPT Incorrect: HIPPA, DSM5-, DRG A patient on Chlorpromazine states his orgasm is dry and afterwards he will commonly have milky urine. The APRN realizes this is which of the following? A) This is likely a harmless response to the Chlorpromazine "Thorazine" A condition which results from absence of second female sex chromosome (XO) and is associated with web neck, dwarfism, cubitus valgus and infertility is known as which of the following? B) Turners Syndrome Turners syndrome: tx involves hormone therapy; fertility treatments for women when they decide to have a baby Which of the following would be characterized as a negative s/s of schizophrenia? B & C only B) impaired social and occupational functioning C) isolation and impaired self-care Which of the following are keys to distinguishing OCD from psychosis? Patients with OCD can almost always acknowledge the unreasonable nature of their symptoms If a pregnancy begins while the woman is taking high doses of methadone and withdrawal is desired during which trimester is the least hazardous? D) Withdrawal from methadone should never be done while the woman is pregnant Neurochemical or neurophysiological changes in the body that results from the repeated administration of a drug is known as which of the following? C) Neuroadaption incorrect: cross-tolerance, neurotransformation, neurocognitive adjustment The recurrent and intense sexual arousal from the physical and psychological suffering of another person is known as which of the following? C) Sexual sadism Which of the following is not consistent with the onset of OCD? D) The onset of OCD is typically preceded by OCD personality traits True answers about OCD: -more than 1/2 of pts with OCD have a sudden onset of symptoms -the onset of symptoms for about 50-70% of patients occurs after a stressful event -most patients keep their symptoms secret initially The recurrent urge to expose one's genitals to a stranger is known ass which of the following? C) Exhibitionism Which of the following patients would be appropriate for hospitalization for substance use disorder? Select all that apply D) A&B only (Patients who have a substance overdose who cannot be safely tx in an outpt setting & pts who are at risk for severe or medically complicated withdrawal symptoms The nursing practice model recommendation for NPs by the NAtional Academy of Medicine and the National Council of State Boards of Nursing is which of the following? A) Full practice Which of the following groups does medicare cover? Select all the above A) Individuals 65+ years and older who have enrolled and pay premiums B) Disabled individuals who quality for social security disability payments and benefits Which of the following neurotransmitters increases libidio? D) Dopamine Incorrect: GABA, serotonin, oxytocin Which of the following factors are associated with poor prognosis for patients with OCD? D) A & C (Childhood onset & Co-existing major depressive disorder) Which of the following is inconsistent with current knowledge about schizophrenia? C) Dopamine level is a laboratory tests that assists in the diagnosis of schizophrenia A chronic disorder characterized by repetitive hair pulling leading to variable hair loss that may be..to others known as? C) Trichotillomania Which of the following are risk factors for neuroleptic malignant syndrome? B) Rapid dose escalation C) Parental route of admin D) High potency typical antipsychotics A method of therapy used to tx individuals with substance use based on the fundamental principle of a psychology that reinforced behaviors are likely to be..is known as the following? B) Contingency Management The conditions in which people are born, grow, work, live and age are known as? Social determinants of health All of the following is consistent with the ANCCs rules regarding recertification EXCEPT: A) You are required to have a maximum of 25 credit hours during each certification period Correct: B) you can start the recert process 1 year before your expiration date, but no later than 3 months before C) You must have 1000 clinical practice hours in a clinical speciality within the preceding 5 years D)you must have at least 25 contact hours in pharmacotherapy Risks factors for school violence include which of the following? Select all that apply A) Bullying B) Being bullied C) Isolation Persons who subordinate their own needs to those of others, get others to assume responsibility for major areas in the lives, lack of self-confidence, and may experience intense discomfort when alone for more than a brief period of time are demonstrating characteristics with which of the following personality disorders? C) Dependent personality disorder Incorrect: avoid PD, passive PD, antisocial PD Generalized convulsions, oliguria, and renal failure are symptoms seen with which of the following lithium levels? D) >25 mEq/L (TOXICITY) A form of child abuse in which a patient or character repeatedly fabricates or actually inflicts injury or illness in a child for whom medical intervention is then sought in an ER is known as which of the following? D) Munchausen Syndrome by Proxy Self-care strategies for the ARNP in preparing for the certification exam include all of the following EXCEPT? D) plan to study for short periods over a longer period of time A patient presents with a formal, tense manner. He reluctantly reports a longstanding (since early adulthood) pervasive suspiciousness of others, preoccupied with..trustworthiness of friends, unjustified concerns about others deceiving him, angry about perceived insults and slights, reluctant to confide in the ARNP. The ARNP suspects that the pt likely has which of the following PDs? Which of the following is consistent with what is known about the epidemiology of anxiety? B) Women have a higher lifetime prevalence of anxiety than men Which of the following is consistent with NP practice parameters when prescribing buprenorphine? D) the NP is require to complete specific training to prescribe and dispense buprenorphine Which of the following are consistent with current data related to the prevalence of drinking alcohol? B) Men and women with higher education and income are more likely to drink alcohol A pt with hx of hypoglycemia reports feelings of fear, worry and restlessness that has persisted over the past 6 months. The pt states these feelings are worse when glucose is low. the ARNP suspects the pt has which of the following dx? A_) GAD attributable to another medical condition Which of the following is not consistent with benzo withdrawal? B) The best way to proceed with benzo withdrawal is to stop it immediately and tx withdrawal s/s Which of the following is true about the legal practice of the PMHNP? D) A&B only A) all have some degrees of prescriptive privileges in all states and the district of columbia B) all are considered primary providers in all states and the district of columbia Flashbacks in which the individual may act and feel as if the trauma were reoccurring represent which of the following clinical features of PTSD? A) Intrusion Symptom B) Symptom of Avoidance In which ways are NPs and PAs different? D) A&B A) NPs differ from PAs in legal definition, scope of practice, licensure, and independence of practice B) NPs practice under their own license and independent of the physician, PAs always work under the supervision of a physician Which of the following initials would a PMHNP use to designate appropriate credentials? PMHNP-BC Variations from norms in gender roles such as toy preferences, rough and tumble play, aggression, or playmate gender is known as which of the following? B) Gender role behavior 3 major neurotransmitters associated with anxiety, based on animal studies and response to drug tx include? B) GABA, norepinephrine and serotonin Which of the following is consistent with the epidemiology of schizophrenia in the US? D) Onset of schizophrenia before the age of 25 is extremely rare Clinical findings that may indicate abuse include which of the following? Select all that apply B) Explanation by the pt which is inconsistent with the type of injury C) Psychological distress such as depression, anxiety, SI, and/or sleep disorder D) Explanation by the parent that is inconsistent with the type of injury According to the APA, which of the following is consistent with the EBP for telepsych? B) In populations with severe anxiety, tele psychiatry is preferred Which of the following is consistent with literature regarding the term psychosexual? D) None of the above -psychosexual is used to describe personality development and functioning -psychosexual is synonymous with libidio in the Freudian sense -Psychosexual basically refers only to sexual feelings and behavior Bleuler identified 4 fundamental s//s of schizophrenia, known as the 4 A's, which include which symptoms? A) Associations, Affect, Autism, Ambivalence The fear/anxiety regarding places from which escape may be difficult is known as which of the following: C) Agoraphobia All of the following are one of the 5 major categories of third-party payers EXCEPT: D) only A & B A) Medicare/medicaid B) Managed care organization (MCOs) Which of the following are risk factors for sexual assault EXCEPT: A) Religion Incorrect: serious mental illness, substance use disorder, family hx of sexual abuse Which of the following is consistent with what is known about PP depression? D) All of the above (feelings of guilt/ and inadequacy are often present and excessive; thoughts of harming the baby are often present; typical onset is within 3-06 months of delivery) Affirmatively acting to benefit another or others, going beyond what is required by law is known as which of the following?> C) Beneficence Which of the following is used for treating alcohol dependence individuals seeking to continue to remain alcohol free after they have stopped drinking? D) Acamprosate The NP can impact health policy and healthcare by doing which of the following? D) All of the above -becomes an active member of local, state, and/or national NP -becomes familiar with the resources available on NP organization websites -Volunteer to serve on legislature committees within professional NP organizations The tx of others equitably and distribution of benefits/burdens fairly is known as? B) Justice Which of the following is INCONSISTENT with current literature about victims of sexual abuse? C) The pre-existing relationship and\ familiarity with the abuser may impeded the victim's ability to make rational decisions Which of the following would constitute negligence? Select all that apply Cluster B a., antisocial b. borderline c. histrionic d. narcissistic inner emptiness, unstable relationships and emotional dysregulation? BPD Attention seeking and excessive emotionability? Histrionic Social irresponsibility, diregard for others, deceitfulness, and manipulation of others for personal gain Antisocial Self-grandiosity, need for admiration and lack of empathy Narcissistic PD Eccentric ideas and behaviors PD? Schizotypal PD Disinterest in others PD? Schizoid Mistrust and suspicion PD? Paranoid PD Characterized by appearing anxious or fearful. it includes which PDs? Cluster C a. avoidant PD b. dependent PD c. obsessive compulsive PD Perfectionism, rigidity and obstinacy traits PD? OCD PD Avoidance of interpersonal contact due not rejection sensitivity PD? `Avoidant Submissiveness and a need to be taken care of PD? Dependent PD Which of the following is NOT consistent with recommendations for psychiatric hx taking and the MSE of older adults? B) Pt should be seen alone even in cases of clear evidence of impairment to persevere the privacy of a doctor/pt relationship Low health literacy has been linked with which of the following? D_ All of the above -poor health outcomes -lower rates of hospitalization -less frequent use of preventative services A claim of malpractice requires that a patient/plaintiff prove which of the following? Select all that apply A) The existence of a client-professional relationship--duty ti care C) a causal link b/t the provider's failure to confirm to tx standards and harm to the pt D) Actual injury to the pt According to USDHHS and the Federal Bureau of Primary Health Care, which of the following individuals would be considered homeless? D) All of the above -an individual whose primary residence during the night is a supervised public or private facility that provides temporary living accommodations -an individual who is a resident in transitional housing -a person who is living w /a friend` A particular form of psychotherapy used for pts with BPD, especially those with parasuicidal behaviors, such as frequent cutting is known as which of the following? A) DBT incorrect: mentalization based tx; transference focused psychotherapy and exposure therapy` As a pmhnp, one of the most common areas you will counsel your patients about is the importance of sleep hygiene. Which of the following is NOT consistent with common recommendations for good sleep hygiene? B) Set a cool room temp True sleep hygiene tips: -avoid alcohol and caffeine -set TV to turn off within 1 hr of falling asleep -go to bed at the same time each night The need for NPs to practice to the full extent of their education and training is necessary for which of the following reasons? Select all of the above A) The growth in number and proportion of older Americans B) The projected PCP shortages by 2025 C) increased number of individuals who have access to healthcare according to Freud, stubborn, parsimonious and highly conscientious traits are associated with? B) Anal stage Freud's Psychosexual Theory and 5 Stages of Human Development? 1.Oral stage 2. Anal stage 3. Phallic stage 4. Latent stage 5. genital stage The mouth, sucking, swallowin ect Stage 1- oral stage EGO develops in which phase? ORAL phase 1 The penis or vagina-sexual intercourse? Stage 5 genital `The anus- withholding or expelling feces 2. Anal stage Little to no sexual motivation present? Moderate Lithium toxicity: 2.0-2.5 Lithium therapeutic window 0.6-1.2 mEq/L first med approved for bipolar d/o lithium Common side effects of Lithium, tremor, nausea., fatigue, increased thirst, slowed thinking Important serious side effects of Lithium: hypothyroidism, weight gain, diabetes insipidus, and lithium toxicity How do we decrease the risk of lithium toxicity? Blood level monitoring therapeutic range: 0.6 - 1.2 Lithium levels are known to (increase/decrease) when used concurrently with diuretics, thiazides, ACE inhibitors and NSAIDs? Increase ACE inhibitors: lisinopril, catopril, enalapril Lithium levels are known to (increase/decrease) when used with drugs including caffeine, acetazolamide and theophylline Decrease concurrent use of lithium and antidepressants and/or antipsychotics can cause what? Serotonin syndrome & Neuroleptic malignant syndrome The term "suicide survivor" refers to which of the following? A) those who have lost a loved one to suicide At a minimum, a psychiatric evaluation in an emergency should include which of the following? Select all the above C) is the problem organic, functional or a combination? A pt presents with a formal, tense manner. He reluctantly responds a longstanding (since early adulthood) pervasive suspiciousness of others, preoccupied with trustworthiness of friends, unjustified concerns about others deceiving him, angry about perceived insults and slights, reluctant to confide in the ARNP. The ARNP suspects the pt likely has which of the following PDs? B) Paranoid PD The obligation to not inflict harm or balancing unavoidable harm with benefits of good achieved is known as which of the following? B) Beneficence `In about 1/2 the cases in which suicides occur while pts are in a psychiatric unit, a lawsuit occurs. Which of the following is NOT consistent with what court expects related to inpt psych unit suicide events? D) Evidence of formulation of a tx plan with a high level of security Using the LIAASE: A general cultural competency tool, the ARNP would do which of the following? D) all of the above -agree to disagree on differences in values -solicit other options or points of view -acknowledge and validate powerful emotions when expressed Which of the following is NOT consistent with what is known about PP psychosis? A) symptoms of PP psychosis can often begin within days of delivery Concerns when treating geriatric patients with psychotherapeutic drugs includes all of the following EXCEPT: B) Elderly persons may be more susceptible to adverse effects of psychotherapeutic drugs A clause in an employment contract that specifies that an employer and employee may end the working agreement without cause within a specific number of days is known as which? C) Termination clause Standards of care are now being set, modified, monitored and publicized by certain self- appointed consumer-oriented agencies as well as government agencies, including which of the following? D) All of the above -Medicare -the Joint Commission -The agency for healthcare research and quality The differences in the quality of healthcare across individuals and groups in regards to access of care, treatment options, and preventative services is known as? B)Health disparities incorrect: racism, vulnerable populations, SDOH Which of the following medical conditions can present with prominent mental status changes that mimic common psychiatric illnesses. Select all that apply B) Thyroid diseases C) Head trauma Incorrect: DM, AIDS Risks factors for school violence include which of the following? Select all the above A) bullying B) being bullied C) Isolation Being knowledgeable about one's own thoughts, feelings and sensations as well as the ability to reflect on how these can affect one's interactions with others is known as? A) Cultural awareness A pt with an inability to conform to the social norms that ordinarily govern many aspects of a person's behavior is consistent with which of the following PDs? D) Narcissistic PD Which of the following meds are associated with neural tube defects when given during pregnancy? C. Valproic acid curriculum content supports the NP scientific competency area includes which of the following? Select all that apply A) Comparison of pt data sets with evidenced based standards to improve care B) Science from other disciplines relevant to heath care B) Mild bradycardia s/.s of cannabis physical effects? Mild tachycardia, orthostatic hypotension, dilation of the conjunctival blood vessels A conscious standard recurrent behavior such as counting, checking, avoiding that interferes with the person's normal routine and functioning is known as? A_ Compulsion Most everyone has a firm conviction that they are male or female by which age range? B) 2-3 years of age A pt who presents absent movements with difficulty starting activities, flat affect and avolition would be assessed as having? D)_ Pseduo-parkinsonism What of the following is consistent with current epidemiology literature about gender and OCD? D) Adult men and women are equally likely to have OCD A type of schizophrenia in which the individual has a marked disturbance of motor function and may involve stupor, negativism, rigidity, excitement or posturing or mutism is? B) Catatonic A pt who presents with the inability to remain still with motor restlessness, would be assessed to have? B) Akathisia method of therapy used to tx individuals with substance use disorders? B) Contingency Management Ethnocentrism results in which of the following? C) provides care givers the ability to care for pts of various cultures Which of following demographic characteristics is consistent with high suicide risk? D) Over age 45 In educating the pt beginning to take Lithium, the ARNP explains which of the following is related to diet and fluid intake? D) All of the above -caffeine and alcohol act as hydration agents and can raise your lithium concentrations -drink @ least 1 gal of water or more each day & limit your salt intake -if you go on A diet, your doctor may need to increase the frequency of blood tests Three major neurotransmitters associated with ANXIETY, based on animal studies and response to drug tx include? B) GABA, norepinephrine and serotonin What neurotransmitter increases libidio? D) Dopamine Concerns when treating geriatric pts with psychotherapeutic drugs includes all of the following EXCEPT? C) Elderly persons may metabolize psychotherapeutic drugs more rapidly Concerns when treating geriatric pts with psychotherapeutic drugs? A) Elderly people can be more susceptible to adverse effects of drugs B) Elderly persons may metabolize drugs more slowly D) Elderly people may excrete psychotherapeutic drugs more slowly. Persons who subordinate their own needs to those of others, get other to assume responsibility for major areas of their lives, lack self-confidence and may experience intense discomfort when alone for more than a brief period of time are demonstrating characteristics consistent with what PD? C) Dependent PD According to Sullivan, which of the following are consistent with a mentor/mentee relationship? C) Goals for the mentoring relationship are set mutually incorrect: mentors are assigned; mentor relationships are shorter term; A&B only The need for NPs to practice to their full extent of their education and training is necessary: select all of the above ALl of the above 3 MULTIPLE CHOICE OPTIONS The ARNP assessing lifestyle as a social determinant of health would ask about which of the following? A) Diet 3 MULTIPLE CHOICE OPTIONS What are social determinants of health and lifestyle choices? The social determinants of health (SDH) are the non-medical factors that influence health outcomes. They are the conditions in which people are born, grow, work, live, and age, and the wider set of forces and systems shaping the conditions of daily life. In educating the pt about Lithium, the NP explains which of the following is related to diet and fluid intake? D) All of the above 3 MULTIPLE CHOICE OPTIONS The goal of psychotropic tx is to eliminate all manifestations of a disorder to below the syndromal threshold, which is defined as which of the following? B) Remission 3 MULTIPLE CHOICE OPTIONS The NP can impact health policy and healthcare by doing which of the following? D) All of the above 3 MULTIPLE CHOICE OPTIONS A term used to describe individuals and families who are found to live in overcrowded homes, relocate frequently and struggle to pay rent and monthly expenses is which of the following? D) A& B 3 MULTIPLE CHOICE OPTIONS Which of the following is consistent with current literature regarding the epidemiology of dependent PD? C) Persons with chronic physical illness in childhood may be the most susceptible to this disorder 3 MULTIPLE CHOICE OPTIONS Pts who injure themselves by self-mutalization but usually do not wish to die are said to have which of the following? C) Parasuicidial behaviors 3 MULTIPLE CHOICE OPTIONS The NP preceptor should have which of the following? D) All of the above 3 MULTIPLE CHOICE OPTIONS 0.8 - 1.2 -can be as low as 0.6 for some and be therapeutic The obligation to not inflict harm or balancing unavoidable harm with benefits of good achieved is known as? C) Non-maleficence 3 MULTIPLE CHOICE OPTIONS Acknowledging a person's right to make choices, to hold views and take actions based on personal value is known as which of the following? D) Respect for autonomy 3 MULTIPLE CHOICE OPTIONS Narcissistic, BPD, antisocial and histrionic subtypes are part of what cluster of PDs? B) Cluster B Being knowledgeable about one's own thoughts, feelings and sensations as well as the ability to reflect on how these can affect one's interactions with others is known as? A) Cultural awareness The NP recognizes which are the long-term effects of sex trafficking on victims? D) All of the above 3 MULTIPLE CHOICE OPTIONS wernickles encephalopathy= considered a medical emergency or not? is a medical emergency Is a degenerative brain disorder caused by lack of vitamin B1 Aim of tx for wernickles encephalopathy Prompt and quick correction of the thiamine deficiency in the brain Is wernickles encephalopathy reversible? it is considered reversible Wernickles encephalopathy is caused from? Alcohol abuse, dietary deficiencies, prolon ged vomiting, eating disorders, effects of chemotherapy =s/s mental confusion, vision problems, coma, hypothermia, low bp, lack of muscle coordination (ataxia) lack of muscle coordination? Ataxia Clinical triad of ophthalmoplegia, ataxia and confusion? Wernickles encephalopathy = acute neurological condition Korsakoff's Syndrome: neuropsychiatric disorder associated with confabulation and significant deficits in anterograde and retrograde memory This disorder is associated with pts fabricating stories in the setting of clear consciousness Korsakoff's A common inciting event that precepitates WE is? an acute infection other triggers include: prolonged carb or glucose loading in the presence of thiamine deficiency Hallmark sign of WE? is ocular abnormalities especially nystagmus other oculomotor s/s: include cranial nerve involvement of oculomotor, abducens and vestibular nuclei causing conjugate gaze palasises; pupillary sluggishness, ptsosis and anisocoria is also common Some pts can present with hyperactive delirium secondary to possible alcohol withdrawal symptoms alongside this disorder? WE Can WE cause death? Yes- less than 5% of pts with WE can present with a severely depressed level of consciousness that will eventually lead to coma or death Warning s/s of WE that could indicate coma or death? Hyperthermia and hypotension other s/s include peripheral neuropathy--lower extremities are normally involved and the exam would reveal distal sensory los clinical dx of WE is present if the pt has two of the following features: A) eye signs B) Dietary deficiency in thiamine C) AMS D) Cerebellar dysfunction Normal brain imaging cannot rule out? WE -therefore not very beneficial What does thiamine do? help brain cells produce energy from sugar Korsakoff's syndrome is often, but not always, preceded by an episode of? WE however, it can occur in someone who has never had a prior episode of WE S/s of Korsakoff's syndrome? problems learning new information, inabilty to remember recent events and long-term memory gaps. =confabulation -hallucinations may be present Cornerstone of effective long term tx of Korsakoffs /WEs? Abstaining fro alcohol and maintaining a healthy diet pt on lithium with a hx of ETOH presents with dry mouth, ataxia, dizziness, abdominal pain and slurred speech-the NP should do what? B) recognizes these are s/s of mild to moderate lithium toxicity--the NP decreases the lithium by half and encourages the pt to drink more fluids walking on eggshells, appeasement and avoidance behaviors by the victim is characteristic of what phase of DV? C) Tension building phase what stage of the cycle of DV is characterized by overt aggressive behavior towards the victim? B) Abusive incident 3 MULTIPLE CHOICE OPTIONS In Canterbury V Spence, listed physician responsibilities for disclosure--which is not listed? D) Inform the pt about precautionary therapy that he/she should seek in the future 3 MULTIPLE CHOICE OPTIONS Which of the following is the tx of choice for pts with depressive personality? C) Insight-oriented psychotherapy 3 MULTIPLE CHOICE OPTIONS Which of the following should be avoided when working with practice guidelines? A) write guidelines with minute details that everyone will follow in the exact same way A claim of malpractice requires a pt/plaintiff prove which of the following? select all that apply B, C & D C) a casual link between the NPs failure to conform to tx standards and harm to the pt D) actual injury to the pt 3 MULTIPLE CHOICE OPTIONS Which of the following is consistent with what is known about terrorist-bomber suicides? D) A&B 3 MULTIPLE CHOICE OPTIONS NP working as an at will employee realizes which of the following. Unless the NP has a contract for a specified term of employment, the employee: D) A&C only 3 MULTIPLE CHOICE OPTIONS The US supreme court upheld the psychotherapist-pt privilege in which of the following cases? A) Jaffee vs Redmond 3 MULTIPLE CHOICE OPTIONS Loyalty, fairness, truthfulness, advocacy and dedication in professional relationships is known as? B) Fidelity 3 MULTIPLE CHOICE OPTIONS Which of the following is consistent with PDs? C) Involves impairment in at least 1 out of 4 areas of cognition, affectivity, interpersonal function or impulse control 3 MULTIPLE CHOICE OPTIONS A late appearing adverse effect of neuroleptic drugs is known as? D) Neuroleptic induced tardive dyskinesia the failure of a professional to exercise that degree of skill and learning commonly applied by the average prudent, reputable member of the profession is known as? B) Malpractice 3 MULTIPLE CHOICE OPTIONS a somatpsychic illness triggered by changing levels of sex steroids that accompany an ovulatory menstrual cycle about one week before the onset of menses characterized by irritability, emotional liability, HA, anxiety and depression is known as? D) Premenstrual psychosomatic disorder 3 MULTIPLE CHOICE OPTIONS persons who exhibit impulsive traits also show high levels of which of the following hormones? select all that apply D) A& C only 3 MULTIPLE CHOICE OPTIONS in educating a pt beginning on lithium, the NP explains which of the following related to need for blood tests? D) A&B only 3 MULTIPLE CHOICE OPTIONS the incidence of suicide is highest for which of the following populations? B) Older white men 3 MULTIPLE CHOICE OPTIONS Which of the following defense mechanisms does the abuser use during the honeymoon phase? B) Projection 3 MULTIPLE CHOICE OPTIONS SIB patients should be engaged in what type of therapy (BPD individuals who engage in SIB) A) DBT 3 MULTIPLE CHOICE OPTIONS the _____stage begins at 18 months of age and lasts until the age of 3 Anal Stage 3 MULTIPLE CHOICE OPTIONS Freud believed that the libidio source shifted from the mouth (in stage 1) to the anus in what stage of development? Anal stagen(stage 2) At what point does a child begin to understand that they have some degree of control over their lives, including when and where they defacate? Anal stage this can lead to difficulties with potty training *primary erogenous zone is pleasure derived from controlling bladder and BMs Adults who are anal retentive tend to be: Stubborn, very neat, rigid and stingy Adults who are anal expulsive tend to be: messy, wasteful and harsh During the ____ stage, the child develops an attraction to the parent of a different sex to them, which is caused the Oedipus Complex for boys and the Electra Complex for girls Phallic stage (stage 3) Phallic stage occurs at what age? lasting from the ages of 3-6 *the libido centers upon the genitalia and children become aware of their bodies when a child recognizes that the parent of another sex is unavailable, the child learns to model their own behavior after the same-sex parent? Phallic stage According to Freud, those who do not exhibit gender appropriate behavior have not completed this stage of psychosexual development? Phallic stage Introjection 3 MULTIPLE CHOICE OPTIONS Which of the following s/s are assoicated with MDD with melancholic features? D) B&C 3 MULTIPLE CHOICE OPTIONS sleep related hallucinations that occur at sleep onset are known as? A) Hypnagogic hallucinations 3 MULTIPLE CHOICE OPTIONS sleep related hallucinations that occur while waking up from sleep are known as? Hypnopompic hallucinations hypnopompic hallucinations are primarily what type of hallucination? visual (86%). between 8-34% involve auditory hallucinations Applied behavioral analysis is typically indicated for which disorder? C) Autism 3 MULTIPLE CHOICE OPTIONS ADHD, impulse contorl, conduct disorder and intellectual disabilities with anxiety disorders are predominant during which age range? B) ages 6-12 3 MULTIPLE CHOICE OPTIONS Which of the following is consistent with what is known about Bipolar I disorder? D) Equal prevalence among men and women Psychotherapy is important tx strategy for young people for which of the following reasons? select all that apply C & D 3 MULTIPLE CHOICE OPTIONS When evaluating a child with poor academic performance, which of the following diagnostic catergories should be considered first? B & D 3 MULTIPLE CHOICE OPTIONS Which of the following meds is FDA approved for the tx of MDD with seasonal variation? D) Buproprion HCL ER 3 MULTIPLE CHOICE OPTIONS a period of at least one week in which both a manic episode and a major depressive episode occur almost daily is consistent with which dx? C) Bipolar I disorder, mixed episode 3 MULTIPLE CHOICE OPTIONS According to APA "psychologists seek to promote accuracy, honesty and truthfulness in the practice of psychology' reflecting which of the following ethical principles? A) Integrity 3 MULTIPLE CHOICE OPTIONS Promoting the Welfare of children and adolescents addresses which of the following ethical issues? C) beneficence 3 MULTIPLE CHOICE OPTIONS Which of the following disorders is characterized by episodic bouts of intake of excessive amount of food without purging or similar compensatory behavior C) Binge eating The ARNP working w a 5 year old child in a busy pediatric practice is seeking to use levl 1 and level 2 cross-cutting symptoms measures. Which of the following is true in this situation? B) These level 1 and 2 assessments can help the NP identify the presenting problem for the kid 3 MULTIPLE CHOICE OPTIONS Which of the following meds are approved by the FDA for treating OCD in children ages 6-17? C) Zoloft (age 6+) 3 MULTIPLE CHOICE OPTIONS A form of CBT that requires attending skills group in addition to individual therapy sessions are known as which of the following? D) DBT 3 MULTIPLE CHOICE OPTIONS Manic episodes are considered distinct when they are separated by what length of time without significant symptoms of mania or hypomania? C) 2 months 3 MULTIPLE CHOICE OPTIONS Which of the following meds are NOT FDA approved to tx restless leg syndrome? B) Modafinil 3 MULTIPLE CHOICE OPTIONS Persistant Depressive Disorder lasts at least? 2 years MDD episodes are separated by how long? at least 2 months The clinician asks the adolescent how long they have been sad--greater than 1 year? C) MDD A dissociation between the pt's experience of sleeping and the objective polygraph measures of sleep is known as which of the following? A) Sleep state misperception (now known as paradoxial insomnia) -disorder which causes people to feel awake even while they are asleep, leading them to underestimate how many hours they sleep at night Which of the following is NOT consistent with the code of ethics for the profession of nursign? C) The code of ethics explicit the primary obligations of nursing profession 3 MULTIPLE CHOICE OPTIONS Which of the following is approved by the FKA to tx OCD in children ages 10-17? Check all that apply D) Clomipramine (Anafranil) -TCA (serotonin and norepinephrine reuptake inhibition) -more SE than SSRIs -considered a second-line med for OCD A variant of Bipolar I disorder characterized by episodes of MDD and hypomania is known as which of the following? D) Bipolar I disorder, hypomanic type 3 MULTIPLE CHOICE OPTIONS Which of the following hormone levels is increased in anorexia nervosa? A) Corticotrophin-releasing hormone Risk factors for NMS? Dehydration, agitation, exhausting, malnutrition, organic brain syndromes, nonschizophrenia mental illness, lithium use, past hx of ECT The mesocortical pathway is responsible for (3): Cognitive function Reward Motivation Antipsychotics provide D2 blockage in what pathway? Mesocoritical this causes: increased EPS SAD? SSRIs tx this Short term side effects of the medications that tx RLS? (Rotigotine, Pramipexole) mild: cause nausea, lightheadedness and fatigue Rotigotine= Neupro (tx RLS) Pramipexole= Mirapex (tx RLS) Dopamine agonists? First medicines used to tx RLS (Mirapex, Neupro, Requip) Do bananas help RLS? yes- eating more vegetables including leafy greens can help Ziprasidone injection is used to tx occurrences with severe agitation in pts with schizophrenia? help[s restore the balance of neurotransmitters- quick relief antipsychotic ATYPICAL Maximum IM dosage of Zipraisdone? 40 mg/day Indicators for a good prognosis in MDDD includes which of the following? select all that apply B & D 3 MULTIPLE CHOICE OPTIONS During an initial interview with a 15 year old female, the PMHNP notes the presence of peripheral edema & Russell's sign; what do these indicate? Anorexia Nervosa peripheral edema can be caused by a variety of conditions, but the presence of Russell's sign indicates possible anorexia. What is Russell's sign? scarring or callouses on the dorsal surface of the hand caused by self-induced vomiting anorexia 82 year old woman arrives at the office with her son; over the past year, she has had trouble remembering once-familiar things, such as phone #s and friends names. She also does not recognize family members who visit often; she has become unusually moody and struggles with written tasks. What is the most likely dx? A) Alzheimers Disease alzheimers can be associated with: deficits in language, motor function and recognition 3 MULTIPLE CHOICE OPTIONS Dementia with Lewy Bodies typically is accompanied by? EPS Huntington's disease is accompanied by? spasmodic movement and incoordination Frontotemporal dementia is normally accompanied by? extremely talkative and disinhibited ___ is one of the most usual symptoms of anxiety and a direct response to the activation of your sympathetic NS shaking The comorbid psychiatric dx frequently associated with anorexia is? OCD OCD-PD is also another comorbidity of those with anorexia Ethical questions about what we "ought" to do or be are addressed within which domain of ethics? Normative ethics looks into the questions that arise regarding how one ought to act in a moral sense. It is also the study of ethical behavior Which of the following meds are approved by the FDA for tx of mania in children 12-17? Lithium first FDA approved med for children ages 12-17 with mania Which of the following is important to realize when tx a child with an anxiety disorder? B. Repeated exposures of a feared situation will always help the child to unlearn the fear response Developmental impairments and disruptive behavior problems are predominant issues during which of the age ranges? A. 0-5 Flashbacks in which the individual may act and feel as if the trauma were reoccurring represent which of the following clinical fts of PTSD A) Intrusive s/s 3 MULTIPLE CHOICE OPTIONS AFAB assigned female at birth AMAB assigned male at birth _____is good for older adults with anxiety and depression? Remeron the smaller the dose of Remeron, the more ________? sedating What medication decreases psychotic s/s, & ruminating thoughts? A) Seroquel 3 MULTIPLE CHOICE OPTIONS *VERY EXPENSIVE, 1 year= 70,000+; approximately $6K/month Tetrabenazine (Xenazine) original VMAT inhibitor for the tx of HD off label used for TD tx Tetrabenazine is less expensive than deutetrabenazine but requires more frequent dosing and may have higher likelihood to causing depression & suicidiality ____is an anticholinergic medication FDA approved to tx EPS but requires TID dosing Trihexyphenidyl (Artane) *Second line tx choice due to TID dosage *only available in PO formulations Common SE of Artane? anticholinergic/antihistamine dry mouth, constipation, urinary retention, sedation, blurred vision (Trihexyphenidyl) Valbenazine (Ingrezza) was the first VMAT inhibitor to? be approved for the tx of TD in 2017 Valbenazine (Ingrezza) is FDA approved to tx: TD; off label to tx HD and tourettes Which medication used to treat TD is used in once daily dosing and is less likely to cause depression? Valbenazine (Ingrezza)-- once daily dosage, start @ 40 mg /day, then after 1 week, can increase to 80 mg/day *EXPENSIVE 6,000/month Avoid with use of _______ when taking any VMAT2 medication, such as Valbenazine (Ingrezza), Tetrabenazine (Xenazine) and duetetrabenazine (Austedo)? MAOIs what medication is used to tx antipsychotic induced weight gain and type 2 diabetes? Metformin average of 3k weight loss Metformin works by _______ appetite while _____insulin sensitivity? decreasing appetite while increasing insulin sensitivity MOA: decreases glucose production by liver and increases insulin sensitivity common se of metformin? GI side effects diarrhea, nausea, abdominal bloating, flatuence and discomfort Typical dose of Metformin used to reduce weight related to antipscyhotics? 500-1000mg BID --average of 3k of weight loss in pts How can you decrease the nausea and diarrhea side effect of Metformin? (affects 50% of patients) take with food or use ER formulation Best tool for assessing TD? AIMS 12 item test, takes approx 10 minutes. Best tool for monitoring the severity of TD What causes TD? antipsychotics but other medications (nausea and reflux meds) can cause TD as well: reglan, compazine and other agents that block dopamine Medications used to tx TD? (3) FDA approved: Valbenazine (Ingrezza) + Deutrabenazine (Austedo) Not FDA approved for TD, but FDA approved for HD: tetrazbenazine (Xenazine) Meds that cause severe weight gain? Antipsychotics- especially clozapine, olanzapine, quetiapine Antidepressants- mirtazepine, TCAs, Paxil Mood stabilizers- Lithium, Valproic Acid meds that cause moderate weight gain? risperidone and invega meds that cause less weight gain? ability, haldol, geodon, lurasidone First line tx for weight gain for psych meds? A. Topamax ----se: cognitive dulling B. Metformin ER C. Olanzapine/Samidorphan (Lybalvi)--used as an alternative to zyprexa to help reduce weight gain D. Orlistat (Xenical). ---se: diarrhea E. Abilify--may be useful for olanzapine induced weight gain as an adjunct Second line tx for weight loss? A. Wellburin SR B. Any stimulant C. Naltrexone/Bupropion (Contrave). --*antiobesity drug D. Phentermine (Suprenza)-*antiobesity drug E. Phentermine/topimate (Qsymia). ---*antiobesity drug F. Glucagon like peptide agonists---such as Liraglutide or Ozempic (Semaglutide) G. Nizatidine (Axid) ---antacid OTC H. Amantadine (symmetrel) Tx of akathisia? First line: propanolol, inderal LA, benzos Reduce dosage DC offending med (Prolactin doses tend to normalize after 2-4 days) If stopping the causation agent is NOT possible? first line= add abilify. 5-20 mg daily 2nd line= add oral contraceptives First line tx of serotonin syndrome? benzos second line= cyproheptadine Fun fact: MNDA in combination with any SSRI can cause serotonin syndrome Sialorrhea? Hypersalivation What drug causes the most sialorrhea? Clozapine is the most common cause (30-80%) other causes: zyrepxa, risperidone or quetiapine First line tx of Sialorrhea? 1= glycopyrrolate (Robinul). --unlike other anticholinergics, glycopyrrloate does not cross the BBB, so ferwer central anticholinergic SE 2nd= Atrovent, Oxybutrin, Cogentin, Clonidine, Atropine, Artane Reducing the dose of Clozapine normally does what to hypersalivation? not helpful in diminishing symptoms epidemology characterstics? observe in age <50 Greatest abnormalities occurs in schizophrenia are related to what structures (2) A. Basal ganglia B. Cerebellum *involved in the control of movement excessive dopamine is associated with Schizophrenia Propanolol (Inderal) treats A. tremors B. Akathisia C. Prevents migraines D. Decreases test anxiety E. Anxiety F. HTN Risk of neutropenia is greatest when taking Clozaril during this time frame? within first 6 months then incidents can occur but are decreased risk Smoking increases Clozaine clearance by? 30-50% Oculogyric crisis? dystonic like reaction where this is abnormal invol movements /deviation of the eyes How to tx an oculogryic crisis? benadryl